DOCSLIB.ORG

HIV and Family Planning Integration in Tanzania Building on the Pepfar Platform to Advance Global Health

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
HIV and Family Planning Integration in Tanzania Building on the Pepfar Platform to Advance Global Health a report of the csis global health policy center HIV and Family Planning Integration in Tanzania building on the pepfar platform to advance global health 1800 K Street, NW | Washington, DC 20006 Author Tel: (202) 887-0200 | Fax: (202) 775-3199 Janet Fleischman E-mail: [email protected] | Web: www.csis.org July 2012 CHARTING our future Blank a report of the csis global health policy center HIV and Family Planning Integration in Tanzania building on the pepfar platform to advance global health Author Janet Fleischman July 2012 CHARTING our future About CSIS—50th Anniversary Year For 50 years, the Center for Strategic and International Studies (CSIS) has developed practical solutions to the world’s greatest challenges. As we celebrate this milestone, CSIS scholars continue to provide strategic insights and bipartisan policy solutions to help decisionmakers chart a course toward a better world. CSIS is a bipartisan, nonprofit organization headquartered in Washington, D.C. The Center’s more than 200 full-time staff and large network of affiliated scholars conduct research and analysis and develop policy initiatives that look to the future and anticipate change. Since 1962, CSIS has been dedicated to finding ways to sustain American prominence and prosperity as a force for good in the world. After 50 years, CSIS has become one of the world’s preeminent international policy institutions focused on defense and security; regional stability; and transnational challenges ranging from energy and climate to global development and economic integration. Former U.S. senator Sam Nunn has chaired the CSIS Board of Trustees since 1999. John J. Hamre became the Center’s president and chief executive officer in 2000. CSIS was founded by David M. Abshire and Admiral Arleigh Burke. CSIS does not take specific policy positions; accordingly, all views expressed herein should be understood to be solely those of the author(s). © 2012 by the Center for Strategic and International Studies. All rights reserved. Cover photo: Reproductive and child health clinic in Iringa, Tanzania, 2012. This health care worker provides integrated family planning services and HIV counseling and testing. Photo credit: Janet Fleischman. Center for Strategic and International Studies 1800 K Street, NW, Washington, DC 20006 Tel: (202) 887-0200 Fax: (202) 775-3199 Web: www.csis.org mbedd hiv and family planning integration in tanzania building on the pepfar platform to advance global health Janet Fleischman1 Executive Summary The President’s Emergency Plan for AIDS Relief (PEPFAR) is well positioned to serve as a foundation for other global health programs, building on its health infrastructure, training, and systems. To fulfill that potential in the vital area of women’s health will require integrating HIV/AIDS services with family planning and reproductive health services. The results from U.S. health investments in Tanzania indicate that this is a feasible and cost-effective strategy to combat the AIDS epidemic and promote the health of women and girls, and through them their families and communities. The lessons being learned in Tanzania should inform the scale up of strategic integration under PEPFAR for these critical interventions. Support for using the PEPFAR platform to provide more comprehensive health services for women, and specifically for family planning, has gained momentum in recent years, based on growing evidence demonstrating the important program synergies and health benefits that flow from these linkages.2 As more women living with HIV access antiretroviral (ARV) treatment, the HIV platform presents a critical opportunity to provide the information and services they need to decide the number and timing of their pregnancies. Importantly, this approach includes preventing new HIV infections by reducing unintended pregnancies, thereby preventing mother- to-child-transmission (PMTCT). Similarly, integrating HIV services into family planning, 1 Janet Fleischman is a senior associate with the CSIS Global Health Policy Center. She conducted the mission to Tanzania with Phillip Nieburg, also a senior associate with the CSIS Global Health Policy Center. 2 See World Health Organization (WHO) and UN Population Fund (UNFPA), “Glion Consultation on Strengthening the Linkages between Reproductive Health and HIV/AIDS: Family Planning and HIV/AIDS in Women and Children,” 2006, http://www.who.int/hiv/pub/advocacymaterials/ glionconsultationsummary_DF.pdf; Rose Wilcher, Willard Cates Jr., and Simon Gregson, “Family Planning and HIV: Strange Bedfellows No Longer,” AIDS 23, sup. 1 (November 2009): s1–s6, http://journals.lww.com/aidsonline/Fulltext/2009/11001/Family_planning_and_HIV__strange_bedfellows _no.1.aspx; Micah Gilmer and Brian Baughan, “Making the Case for Integration,” Tides Foundation, May 2010, http://www.tides.org/fileadmin/user/pdf/Tides-Africa-Fund-HIV-Making-the-Case-for-Integration- Report.pdf. | 1 reproductive health,3 and maternal and child health programs helps prevent HIV infection in women and girls, while increasing access for HIV-infected women to ARV treatment and to PMTCT programs to help ensure that their children remain uninfected. This report examines the situation in Tanzania, where the United States has supported the national government in making notable progress toward integrating HIV services with family planning and reproductive health (RH), particularly through PMTCT programs. Integration in Tanzania has been driven by a number of factors, including political commitment from the national government, specified funding from the United States, and experience brought by some PEPFAR implementing partners in the area of family planning–HIV integration. Yet despite the improved policy environment, ongoing barriers remain in implementation, financing for integration, and integration of family planning as a core component of PEPFAR’s treatment programs. In Tanzania, the United States has made important commitments to provide a more complete range of health services for women and girls, through PEPFAR, the Office of Population and Reproductive Health at the U.S. Agency for International Development (USAID), and U.S. bilateral program activities, all of which fall under the Global Health Initiative (GHI).4 Despite the politics that surround discussions of family planning in the United States and the challenges of integrating vertical programs, there is broad consensus among health experts that HIV and family planning services should be closely linked and that advancing integration is a smart and effective way to expand the impact of U.S. health investments. However, many challenges remain in pursuing integration. In Tanzania, challenges include the large unmet need for family planning among HIV-positive and HIV-negative women; chronic stock-outs of family planning commodities; the need for training and ongoing support for both HIV and family planning providers to ensure quality integrated services; and the severe shortages of health workers. For the U.S. government, challenges revolve around galvanizing domestic bipartisan support for family planning–HIV integration in the current polarized environment, 3 Most public health experts include family planning within the broader context of reproductive health services, such as antenatal and postpartum maternal and newborn care, safe birthing services, prevention and treatment of sexually transmitted infections (STIs), postabortion care, obstetric fistula care, and cervical cancer screening. The WHO definition of reproductive health does not include abortion. 4 On July 3, 2012, the GHI principals—Administrator Rajiv Shah of USAID, Ambassador Eric Goosby of PEPFAR, Director Thomas Frieden of CDC, and Executive Director of GHI Lois Quam—published a joint message stating the office of the Global Health Initiative will be closed and that an office of Global Health Diplomacy will be set up at the State Department. This office will have the mandate to ensure that GHI principles are implemented in the field. GHI country teams will continue to work to implement GHI strategies under the leadership of the U.S. ambassador. See “Global Health Initiative Next Steps—A Joint Message,” U.S. Global Health Initiative, http://www.ghi.gov/newsroom/blogs/2012/194472.htm. At this writing, it is unclear what these changes will mean for the direction of GHI in Washington, and the implementation at the country level. 2 | hiv and family planning integration in tanzania and ensuring that such integration is prioritized and measured. Underlying all these challenges is the need to ensure that the rights of women and girls in Tanzania are respected. In Tanzania, HIV prevalence is 7 percent for females and 5 percent for males; young women aged 15 to 24 are infected at rates four times higher than men their age, and most of these women were infected through sexual transmission. Under the U.S. Global Health Initiative (GHI), the interagency GHI country team in Tanzania has made women’s and girls’ health a priority area, with a special focus on aligning U.S. health programs across delivery platforms and linking HIV with family planning, reproductive health, and maternal, newborn, and child health (MNCH) programs. In a move toward greater effectiveness in the health sector, the Tanzanian government is also bringing these services together under the auspices of the Ministry of Health and Social Welfare’s Reproductive and Child Health Services. Policy Options PEPFAR’s support for expanding linkages between HIV and family planning in Tanzania
Load more

Recommended publications
  • HIV/AIDS in Tanzania: Knowledge Dissemination Systems and Changing Youth Behaviour Donald Anthony Mwiturubani
    HIV/AIDS in Tanzania: Knowledge Dissemination Systems and Changing Youth Behaviour Donald Anthony Mwiturubani Introduction The prevention and control of the spread of HIV/AIDS infection remains a priority of many governments, particularly in sub-Saharan Africa, which is estimated to host about 70 percent of the world’s HIV/AIDS victims (O’Sullivan 2000; USAID 2001; UNICEF, UNAIDS & WHO, 2002). The prevention efforts regarding HIV/AIDS transmission need to ensure that people, particularly those who are more vulnerable, such as youths,1 are not exposed to the HIV/AIDS pandemic, and if exposed, have adequate knowledge and skills to prevent infec- tions (Barnett and Whiteside 2002; UNICEF, UNAIDS & WHO, 2002). This needs an approach which provides vulnerable groups such as youths with informa- tion and skills, and empowers them to participate in the design and implementation of the programmes that target them (Colling 1998; Shapiro et al., 2003). Two systems of knowledge dissemination exist, namely modern, such as through mass media, and local, such as through stories. For the local methods of knowledge dissemination, the communicator and audience must be present and should speak the same language. On the other hand, in understanding the infor- mation and skills provided through modern systems, two aspects are important: one, reliable income for purchasing sources of information, such as radio and newspapers, and second, education for using and understanding the informa- tion and skills. Insisting on the role of education in acquiring knowledge about HIV/AIDS through modern systems, UNICEF, UNAIDS & WHO (2002:26) note that: Good-quality education fosters analytical thinking and healthy habits.
    [Show full text]
  • Situation Analysis of Newborn Health in Tanzania
    Situation analysis of newborn health in Tanzania Current situation, existing plans and strategic next steps for newborn health United Republic of Tanzania The content of this publication and opinions expressed herein are those of the authors and do not necessarily refl ect the views of partner agencies or organisations. This publication may be used or reproduced for educa- tional or non-commercial purposes, provided that the material is accompanied by an acknowledgment. Suggested citation: Manji, K. Situation analysis of newborn health in Tanzania: Current situation, existing plans and strategic next steps for newborn health. Dar es Salaam: Ministry of Health and Social Welfare, Save the Children; 2009. TABLE OF CONTENTS Foreword 4 Acknowledgments 5 Acronyms 6 Introduction 7 Chapter 1: The state of Tanzania’s newborns 11 Neonatal survival: current levels and trends 11 Causes of newborn death and illness in Tanzania 12 Maternal health and newborn survival 17 Poverty, inequity and social determinants of illness and mortality 17 Chapter 2: Coverage and quality of services for newborn health 19 Saving newborn lives through a continuum of care 19 Antenatal care 19 Childbirth and intrapartum care 24 Postnatal care 28 Chapter 3: Newborns in the context of the Tanzanian health care system 33 Structure of the Tanzanian health system relating to newborn health 33 Newborn health within existing national plans 37 Financing for newborn health 39 Role of development partners and civil society 40 Chapter 4: Strengths, challenges and opportunities for
    [Show full text]
  • United Republic of Tanzania Ministry of Health and Social Welfare The
    United Republic of Tanzania Ministry of Health and Social Welfare The National Road Map Strategic Plan To Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania 2008 - 2015 April 2008 The National Road Map Strategic Plan -2008 - 2015 i When a woman undertakes her biological role of becoming pregnant and undergoing childbirth, the society has an obligation to fulfil her basic human rights, which include the right to life, liberty social security, maternity protection and non discrimination. 2ii TABLE OF CONTENTS Abbreviations ............................................................................................................................................ iv Foreword.................................................................................................................................................... vii Acknowledgements ................................................................................................................................... viii Chapter 1: Overview ................................................................................................................................................... 1 1.1 Introduction ..................................................................................................................................... 1 1.2 Initiatives to Improve Maternal, Newborn and Child Health in Tanzania ...................................... 1 1.3 Rationale for the Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania.........................................................................................
    [Show full text]
  • Health Sector Strategic Plan July 2021 – June 2026 (HSSP V)
    United Republic of Tanzania Ministry of Health, Community Development, Gender, Elderly and Children Health Sector Strategic Plan July 2021 – June 2026 (HSSP V) Leaving No One Behind Foreword On 1stJuly, 2020, the World Bank declared that Tanzania has been categorised Tanzania as a lower middle-income country (LMIC) after achieving economic and human development consistent with a middle-income status. This goal was achieved five years ahead of the country's schedule of 2025 as indicated in the Tanzania Development Vision 2025. The government’s investment in the health sector has contributed to attainment of the LMIC status by improving the health and the health status of Tanzanians. The key attributes contributing to this achievement include the discipline in financial expenditure, the prevailing peace and tranquillity, reinforcement of leadership ethics, implementation of flagship projects and investment in human development which are the hallmarks of the Sixth phase Government under Her Excellency Samia Suluhu Hassan, the President of the United Republic of Tanzania. The report of the Mid-Term Review (MTR) of Health Sector Strategic Plan Four and the Annual Health Sector Performance Report of July 2020 highlight the achievements made in the health sector during the first five years of implementing Sustainable Development Goals (SDG). The gaps identified have informed the development of the fifth Health Sector Strategic Plan 2021-2026 (HSSP V) which aims to achieve the targets for the last five years of TDV2025 and the second five years of SDGs. The health sector interventions in the HSSP V are also guided by the ruling party election manifesto and the third Five Year Development Plan 2021/22 – 2025/26.
    [Show full text]
  • Guideline for Councils for the Preparation of Plan and Budget for Nutrition
    The United Republic of Tanzania GUIDELINE FOR COUNCILS FOR THE PREPARATION OF PLAN AND BUDGET FOR NUTRITION Prime Minister’s Office P.O Box 3021 Second Edition DAR ES SALAAM October, 2012 Cover photo credit: UNICEF Tanzania/2010/Sala Lewis 2 | P a g e Contents 1. Introduction ................................................................................................... 5 High level commitments for nutrition ................................................................................................. 5 Purpose of the guideline ...................................................................................................................... 6 2. Malnutrition in Tanzania ............................................................................... 7 Magnitude of the problem .................................................................................................................. 7 Causes .................................................................................................................................................. 8 Consequences ...................................................................................................................................... 9 3. Situation analysis for planning and budgeting for nutrition ......................... 10 4. What each sector can do to improve nutrition ............................................ 11 Planning.............................................................................................................................................. 12
    [Show full text]
  • Maternal and Sexual Reproductive Health Situation in Tanzania
    Helpdesk Report Maternal and sexual reproductive health situation in Tanzania Kerina Tull University of Leeds Nuffield Centre for International Health and Development 3 June 2020 Questions What are the main maternal health interventions in Tanzania, and who are the key players? Please include the gaps in provision that are identified in the literature. What does the literature tell us about the impact of COVID-19 on the provision of Sexual and Reproductive Health and Rights (SRHR) in Tanzania? Contents 1. Summary 2. Maternal health in Tanzania 3. Main maternal health interventions 4. Main donors and INGOs in maternal health programmes 5. Main INGOs with maternal and SRHR programmes 6. Options to fill gaps through additional support 7. SRHR gaps in Tanzania during COVID-19 and beyond 8. References The K4D helpdesk service provides brief summaries of current research, evidence, and lessons learned. Helpdesk reports are not rigorous or systematic reviews; they are intended to provide an introduction to the most important evidence related to a research question. They draw on a rapid desk- based review of published literature and consultation with subject specialists. Helpdesk reports are commissioned by the UK Department for International Development and other Government departments, but the views and opinions expressed do not necessarily reflect those of DFID, the UK Government, K4D or any other contributing organisation. For further information, please contact [email protected]. 1. Summary Maternal mortality in Tanzania has not benefited from similar trends as that of child mortality rates, which have decreased greatly in recent years. Sexual and reproductive health (SRH) is also challenging, especially for adolescents.
    [Show full text]
  • Health Budget Brief 2018 Tanzania
    Photography: © UNICEF Tanzania HEALTH BUDGET BRIEF 2018 TANZANIA Key Messages and Recommendations » The health sector was allocated Tanzanian Shillings (TSh) The bulk of the difference came from a massive reduction 2.22 trillion in Fiscal Year (FY) 2017/2018. This represents in donor-financed development spending. TSh338 billion a 34 per cent nominal increase on FY 2016/2017 or a 28 per was slated to be provided to the MoHCDGEC while only cent increase once adjusting for inflation. The health budget TSh12 billion was released. accounts for 7 per cent of the national budget and 1.8 per cent of gross domestic product (GDP). While accounting » Improvements to national revenue forecasting and health for nearly 10 per cent of the total budget in FY 2013/2014 donor coordination are required to improve national level it decreased to 7 per cent in FY 2017/2018. health budget execution. » The largest increase to the health sector in FY 2017/2018 » Over the past five years, donor contributions to the sector has been foreign-funded development spending which have fluctuated significantly. For instance, the share of donors is estimated to increase by 127 per cent on the previous in the development budget has declined from 92 per cent year. However, recurrent spending within the Ministry of to 57 per cent between FY 2013/2014 and FY2017/2018. Health, Community Development, Gender, Elderly and Children (MoHCDGEC) has reduced from 44 per cent in » Health outcomes for the poor in Tanzania have been FY 2013/2014 to 30 per cent in FY 2017/2018. improving.
    [Show full text]
  • Focused Antenatal Care in Tanzania
    2014 Focused COUNTRY-LEVEL PROGRAMMES COUNTRY-LEVEL Antenatal Care in Tanzania Delivering individualised, targeted, high-quality care In 2002, Tanzania’s Ministry of Health and Social Welfare implemented an ANC program adapted from the World Health Organisation’s focused ante- natal care (FANC) model. With four visits throughout pregnancy, FANC integrates care through health promotion, prevention, detection and treatment of existing diseases, and birth preparedness. While providing quality ANC is the first priority, the FANC model also recognises that the antenatal period is a key entry point for many women into the health system, and so the model integrates ANC with care and counselling related to several other conditions. autHORS ANNIE KEARNS, Women and Health Initiative & Maternal Health Task Force taYLOR HURST, Harvard School of Public Health JACQUELYN CaGLIA, Women and Health Initiative & Maternal Health Task Force ANA LANGER, Women and Health Initiative & Maternal Health Task Force overvIEW OF tanZANIA Constitution since 2012, aiming for completion in 2015 before the next general elections in October of that year.4 Tanzania, officially the United Republic of Tanzania, is an east African country lying just south of the equator and bordering the Demographics Indian Ocean, with Kenya to its north, Mozambique to its south, Since its first census in 1967, Tanzania’s population has grown and the Democratic Republic of the Congo, Burundi, Rwanda, from 12.3 million to 47.7 million.3 With an annual population and Uganda to its west.1 It is formed by two states – mainland growth of 3.1%, the population is projected to reach 81.9 million Tanzania and the islands of the semi-autonomous state of in 2030.5 The population density varies greatly across the country, Zanzibar (see Figure 1).
    [Show full text]
  • Country Progress Report 2006
    UNGASS Indicators Country Report Country: UNITED REPUBLIC OF Template TANZANIA TANZANIA COMMISSION FOR AIDS (TACAIDS) FOLLOW-UP TO THE DECLARATION OF COMMITMENT ON HIV/AIDS (UNGASS) Reporting period: January 2003 – December 2005 TABLE OF CONTENTS 1.0 STATUS AT A GLANCE 4 1.1 Communities and Household HIV/AIDS Indicator Survey 4 1.2 HIV Surveillance Report (2003-2005) 4 1.3 Reason for the Spread of the Epidemic 5 2.0 OVERVIEW OF THE AIDS EPIDEMIC 5 3.0 Impact Indicators 6 3.1 Reduction in HIV Prevalence 6 3.1.1 Indicator: Prevalence of HIV Among Youth 6 3.2 HIV Treatment: Survival After 12 Months on Antiretroviral Therapy 7 3.2.1 Indicator: Percentage of Adults and Children with HIV Still Alive and known to be on Treatment 12 Months After Initiation of Antiretroviral Therapy 7 3.3 Reduction in mother-to-child transmission 7 3.3.1 Indicator: Percentage of HIV infected infants born to HIV-infected mothers 7 4.0 NATIONAL RESPONSE TO THE AIDS EPIDEMIC 7 4.1 National Response on HIV/AIDS 7 4.2 Formulation of a National HIV/AIDS Care and Treatment Plan 10 4.3 Support for the Implementation of the Three Ones Principle 10 4.3.1 One National Coordinating Authority 10 4.3.2 One Agreed AID Action Framework 11 4.3.3 One Agreed Country Level Monitoring and Evaluation System 12 4.4 Development Partner Joint Support to National Response on HIV/AIDS 12 4.4.1 CCA/UNDAF 12 4.4.2 UN-ISP 12 4.4.3 UN Coordinating Entity 12 4.5 Response to Most at Risk Populations-HIV Testing 12 4.5.1 Voluntary Counselling and Testing (VCT) 12 4.5.2 Number of Clients Requesting
    [Show full text]
  • Nutrition Public Expenditure Review
    PUBLIC EXPENDITURE REVIEW ON NUTRITION SECTOR FOR MAINLAND TANZANIA UNITED REPUBLIC OF TANZANIA MINISTRY OF FINANCE PUBLIC EXPENDITURE REVIEW OF THE NUTRITION SECTOR MAIN REPORT MARCH 2014 INN VEX PUBLIC EXPENDITURE REVIEW ON NUTRITION SECTOR FOR MAINLAND TANZANIA CURRENCY EQUIVALENT 2010/11 (A VERAGE ) USD 1 = TZS 1,420 EUR 1 = TZS 1,883 GBP 1 = TZS 2,195 2011/12 (A VERAGE ) USD 1 = TZS 1,563 EUR 1 = TZS 2,176 GBP 1 = TZS 2,507 2012/13 (A VERAGE ) USD 1 = TZS 1,562 EUR 1 = TZS 2,009 GBP 1 = TZS 2,476 MEASURES METRIC SYSTEM FISCAL YEAR 1 JULY – 30 JUNE Acknowledgement : In addition to consultants from INNNOVEX Development Consulting Ltd, the study was under the Assistant Commissioner of Budget, Ministry of Finance Mr John Mwilima and coordinated by Mr Charles Mwamwaja. The field work to the 15 selected local councils included the Government staff as follow: Mrs Rachel Ntiga (MoF); Mr Emmanuel Matiku (MoF); Mr Martin Tupilike (MoF); Mrs Aneth Nombo (TFNC); and Mr Fred Lwoga (TFNC). The national team also highly appreciated direct and indirect support from many stakeholders and notably the support team documented on Annex B of this report. INNOVEX©2014 Page | ii PUBLIC EXPENDITURE REVIEW ON NUTRITION SECTOR FOR MAINLAND TANZANIA TABLE OF CONTENTS Abbreviations and Acronyms ...................................................................................................................................................... v Executive Summary .................................................................................................................................................................
    [Show full text]
  • Tanzania Pac-Fp Country Brief
    TANZANIA PAC-FP COUNTRY BRIEF Postabortion care (PAC) provides a comprehensive approach to preventing morbidity and mortality caused by abortion complications (PAC Consortium, 2014). As per the U.S. Agency for International Development (USAID) PAC model, a critical component of PAC is providing access to family planning (FP) counseling and services. Providing these services helps meet the reproductive intentions of women who most clearly demonstrate an unmet need for FP, reduces unintended pregnancies, and prevents repeat abortions, thus reducing maternal deaths (Curtis, Huber, and Moss-Knight, 2010). The information below highlights the United Republic of Tanzania’s investment in providing PAC and FP services to women in need. POLICIES, LEADERSHIP, AND GOVERNANCE PAC TRAINING AND STANDARDS The United Republic of Tanzania’s national family planning In 2000, the MoHCDGEC added comprehensive PAC (FP) and reproductive health (RH) policy is outlined in (referred to as cPAC) to its list of essential RH and child a number of documents, including the National Family health interventions. cPAC includes the emergency treatment Planning Costed Implementation Plan 2010–2015 (updated in of complications of abortion as well as postabortion FP 2013) and the National Road Map Strategic Plan to Improve counseling and voluntary service delivery (Mwanga et al., Reproductive, Maternal, Newborn, Child, and Adolescent 2013). Health in Tanzania: One Plan II 2016–2020 (2016). Among many objectives, the country’s strategic plan aims to scale EngenderHealth’s Access, Quality and Use in Reproductive up and strengthen FP services (especially long-acting Health Project (ACQUIRE) trained service providers in an methods and community-based distribution of contraceptive effort to understand how to incorporate PAC into national commodities) and to integrate FP services into other RH and health systems service delivery.
    [Show full text]
  • Intersectoral Health Action in Tanzania: Determinants and Policy Implications
    A Service of Leibniz-Informationszentrum econstor Wirtschaft Leibniz Information Centre Make Your Publications Visible. zbw for Economics Simon, Michael; Tsegai, Daniel; Fleßa, Steffen Working Paper Intersectoral health action in Tanzania: Determinants and policy implications ZEF Discussion Papers on Development Policy, No. 172 Provided in Cooperation with: Zentrum für Entwicklungsforschung / Center for Development Research (ZEF), University of Bonn Suggested Citation: Simon, Michael; Tsegai, Daniel; Fleßa, Steffen (2012) : Intersectoral health action in Tanzania: Determinants and policy implications, ZEF Discussion Papers on Development Policy, No. 172, University of Bonn, Center for Development Research (ZEF), Bonn This Version is available at: http://hdl.handle.net/10419/84804 Standard-Nutzungsbedingungen: Terms of use: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Documents in EconStor may be saved and copied for your Zwecken und zum Privatgebrauch gespeichert und kopiert werden. personal and scholarly purposes. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle You are not to copy documents for public or commercial Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich purposes, to exhibit the documents publicly, to make them machen, vertreiben oder anderweitig nutzen. publicly available on the internet, or to distribute or otherwise use the documents in public. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, If the documents have been made available under an Open gelten abweichend von diesen Nutzungsbedingungen die in der dort Content Licence (especially Creative Commons Licences), you genannten Lizenz gewährten Nutzungsrechte. may exercise further usage rights as specified in the indicated licence. www.econstor.eu ZEF-Discussion Papers on Development Policy No.
    [Show full text]